Kelli Marie Young, D.O.

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

39231 Issued in SC

Practice address

2095 Henry Tecklenburg Dr
Charleston, SC 29414-5733

Phone

(843) 402-1037

Fax

(843) 402-1295

NPI assigned

Jun 29, 2009

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in SC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Emergency Medicine

Education

Philadelphia College of Osteopathic Medicine, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Broad River Physicians Group, LLCGroup PAC ID 8123385143, 70 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Bon Secours-St Francis Xavier Hospital Hospital, Charleston, SC, CCN 420065
• Roper St Francis Hospital-Berkeley Inc Hospital, Summerville, SC, CCN 420110
• Roper Hospital Hospital, Charleston, SC, CCN 420087
• Mount Pleasant Hospital Hospital, Mount Pleasant, SC, CCN 420104

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Broad River Physicians Group, LLC

  • Emergency Medicine Physician
  • Summerville, SC
  • NPI 1295443000
  Medicare reassignment Care Compare group NPD
• Bon Secours St Francis Xavier Hospital, Inc.

  • Emergency Medicine Physician
  • Charleston, SC
  • NPI 1770867442
  Medicare reassignment NPD
• Roper Hospital Inc

  • Emergency Medicine Physician
  • Moncks Corner, SC
  • NPI 1104983055
  Medicare reassignment NPD
• Roper St. Francis Mount Pleasant Hospital

  • Cardiovascular Disease Physician
  • Mt Pleasant, SC
  • NPI 1629499298
  Medicare reassignment NPD
• Bon Secours St. Francis Xavier Hospital, Inc.

  • Pediatrics Physician
  • Charleston, SC
  • NPI 1982583068
  NPD
• Roper Hospital Inc

  • Emergency Medicine Physician
  • Charleston, SC
  • NPI 1902991607
  NPD
• Roper Hospital Inc.

  • Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
  • N. Charleston, SC
  • NPI 1104563758
  NPD
• Roper St. Francis Mount Pleasant Hospital

  • Critical Care Medicine (Internal Medicine) Physician
  • Mt Pleasant, SC
  • NPI 1578362232
  NPD
• Roper St. Francis Mount Pleasant Hospital

  • Emergency Medicine Physician
  • Mount Pleasant, SC
  • NPI 1649587270
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Bon Secours St. Francis Xavier Hospital Inc.

  • General Acute Care Hospital
  • Charleston, SC
  • NPI 1851361778
  Care Compare affiliation
• Roper Hospital, Inc

  • General Acute Care Hospital
  • Charleston, SC
  • NPI 1962472860
  Care Compare affiliation
• Roper St Francis Hospital-Berkeley Inc.

  • General Acute Care Hospital
  • Summerville, SC
  • NPI 1336603646
  Care Compare affiliation
• Roper St. Francis Mount Pleasant Hospital

  • General Acute Care Hospital
  • Mt Pleasant, SC
  • NPI 1255645644
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1246233600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607299200000",
    "number": "1033347083",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 602645",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282602645",
            "telephone_number": "843-789-1620",
            "fax_number": "843-724-2454"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2095 HENRY TECKLENBURG DR",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294145733",
            "telephone_number": "843-402-1037",
            "fax_number": "843-402-1295"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YOUNG",
        "first_name": "KELLI",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-06-29",
        "last_updated": "2020-12-07",
        "certification_date": "2020-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "PA",
            "license": "OT013177",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "SC",
            "license": "39231",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "392319",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Elizabeth H.B. Young, MSP, CCC-SLP
• Emily McMahon Young, DNP
• Isabella Zareen-Taj Young
• Jesse Dalton Young, PHARMD
• Katherine Harris Young, FNP
• Kimberly Young, M.D.
• Laura Michelle Young, LISW-CP, LCSW,CCM
• Madison Carter Young, CGC
• Makenzi Young
• Margaret Young, RDN, LD

• Emergency Medicine Physician in Charleston, SC
• Providers in Charleston, SC by specialty
• Emergency Medicine Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.